Retrograde approach for the recanalization of coronary chronic total occlusion: collateral selection and collateral
Jian-Ying Ma1, Ju-Ying Qian, Lei Ge
1Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China.
Insights
The retrograde approach effectively recanalizes coronary chronic total occlusions (CTOs), with septal collaterals being preferable. Careful technique is needed for epicardial collaterals to avoid perforation risks.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Access Techniques
Background:
- The retrograde approach is utilized for percutaneous coronary intervention in chronic total occlusions (CTOs).
- This study evaluates the efficacy and complications of the retrograde approach in CTO treatment.
Purpose of the Study:
- To assess the success rate of CTO recanalization using the retrograde approach.
- To identify and analyze collateral-related complications associated with this technique.
Main Methods:
- Eighty-four patients undergoing retrograde CTO recanalization from July 2005 to July 2012 were analyzed.
- Patient demographics, procedural outcomes, and in-hospital events were retrospectively evaluated.
Main Results:
- The overall recanalization success rate was 79.8%.
- Septal collaterals were used more frequently (81%) than epicardial collaterals (19%).
- Successful retrograde wire passage was achieved in 72.6% of patients, significantly correlating with higher recanalization success (93.1% vs. 50%).
- Epicardial collateral use was associated with a higher risk of perforation (18.8% vs. 0%).
Conclusions:
- The retrograde approach is effective for CTO recanalization, with septal collaterals being the preferred route.
- Careful device manipulation is crucial when using epicardial collaterals to mitigate perforation risks.
Background:
The retrograde approach through collaterals has been applied in the treatment of chronic total occlusion (CTO) lesions during percutaneous recanalization of coronary arteries. This study was to investigate the success rate of recanalization and collateral related complications in patients when using the retrograde approach.
Methods:
Eighty-four cases subjected to retrograde approach identified from July 2005 to July 2012 were included in this study. Patient characteristics, procedural outcomes and in-hospital clinical events were evaluated.
Results:
Mean age of the patient was (59.6 ± 11.2) years old and 91.7% were men. The target CTO lesions were distributed among the left anterior descending artery in 45 cases (53.5%), left circumflex artery in one case (1.2%), right coronary artery in 34 cases (40.5%), and left main in four cases (4.8%). The overall success rate of recanalization was 79.8%. The septal collateral was three times more frequently used for retrograde access than the epicardial collateral, 68/84 (81%) vs. 16/84 (19%). Successful wire passage through the collateral channel was achieved in 58 (72.6%) patients. The success rate of recanalization was 93.1% (54/58) in patients with and 50% (13/26) in patients without successful retrograde wire passage of the collateral channel (P < 0.01). Successful retrograde wire passage through the collaterals was achieved in 49 of 68 septal collaterals (72.1%) and in 9 of 16 epicardial collaterals (56.3%) (P = NS). There was no significant difference between the septal collateral group and the epicardial group in the success rate of recanalization after retrograde wire crossing the collaterals (91.8% vs. 100%, P > 0.05). CART or reverse CART technique was used in 15 patients, and 14 patients (93.3%) were recanalized successfully. Collateral related perforation occurred in three (18.8%) cases with the epicardial collateral as the first choice (compared with the septal collateral group (0), P < 0.01). There were 17 (20.2%) patients failure of recanalize the CTO lesions, among which 13 (15.5%) were due to the failure of retrograde wire crossing the collaterals.
Conclusions:
The retrograde approach is an effective technique to recanalize CTO lesions, the septal collateral was preferable. When the epicardial collateral is selected, careful manipulation of devices and wires is essential due to the potential risk of perforation of collateral channels.
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